Acute and Critical Care

Original Articles

Nephrology
A clinical risk score for predicting acute kidney injury in sepsis patients receiving normal saline in Northern Thailand: a retrospective cohort study: Phaweesa Chawalitpongpun, Sukrit Kanchanasurakit, Nattha Sanhatham, Warinda Sasom, Siriwan Thanommim, Araya Senpradit, Wuttikorn Siriplabpla; Acute Crit Care. 2024;39(3):369-378. Published online August 30, 2024; DOI: https://doi.org/10.4266/acc.2024.00514

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Abstract PDF Supplementary Material: Background
Normal saline is commonly used for resuscitation in sepsis patients but has a high chloride content, potentially increasing the risk of acute kidney injury (AKI). This study evaluated risk factors and developed a predictive risk score for AKI in sepsis patients treated with normal saline.
Methods
This retrospective cohort study utilized the medical and electronic health records of sepsis patients who received normal saline between January 2018 and May 2020. Predictors of AKI used to construct the predictive risk score were identified through multivariate logistic regression models, with discrimination and calibration assessed using the area under the receiver operating characteristic curve (AUROC) and the expected-to-observed (E/O) ratio. Internal validation was conducted using bootstrapping techniques.
Results
AKI was reported in 211 of 735 patients (28.7%). Eight potential risk factors, including norepinephrine, the Acute Physiology and Chronic Health Evaluation II score, serum chloride, respiratory failure with invasive mechanical ventilation, nephrotoxic antimicrobial drug use, history of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers use, history of liver disease, and serum creatinine were used to create the NACl RENAL-Cr score. The model demonstrated good discrimination and calibration (AUROC, 0.79; E/O, 1). The optimal cutoff was 2.5 points, with corresponding sensitivity, specificity, positive predictive value, and negative predictive value scores of 71.6%, 72.5%, 51.2%, and 86.4%, respectively.
Conclusions
The NACl RENAL-Cr score, consisting of eight critical variables, was used to predict AKI in sepsis patients who received normal saline. This tool can assist healthcare professionals when deciding on sepsis treatment and AKI monitoring.

Meta-analysis
Association of nutrition risk screening 2002 and Malnutrition Universal Screening Tool with COVID-19 severity in hospitalized patients in Iran: Ghazaleh Eslamian, Sohrab Sali, Mansour Babaei, Karim Parastouei, Dorsa Arman Moghadam; Acute Crit Care. 2022;37(3):332-338. Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2021.01830

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Background
Malnutrition affects normal body function and is associated with disease severity and mortality. Due to the high prevalence of malnutrition reported in patients with coronavirus disease 2019 (COVID-19), the current study examined the association between malnutrition and disease severity in hospitalized adult patients with COVID-19 in Iran.
Methods
In this prospective observational study, 203 adult patients with COVID-19 verified by real-time polymerase chain reaction test and chest computed tomography were recruited from those admitted to a university hospital in Iran. To determine COVID-19 intensity, patients were categorized into four groups. Malnutrition assessment was based on the Malnutrition Universal Screening Tool (MUST) and nutrition risk screening score (NRS-2002). An ordinal regression model was run to assess the association between malnutrition and disease severity.
Results
In the studies sample of Iranian patients with COVID-19, 38.3% of patients had severe COVID-19. According to NRS-2002, 12.9% of patients were malnourished. Based on MUST, 2% of patients were at medium, and 13.4% of patients were at high risk of malnutrition. Malnutrition was associated with a higher odds of extremely severe COVID-19 according to NRS-2002 (odds ratio, 1.38; 95% confidence interval, 0.21–2.56; P=0.021).
Conclusions
Malnutrition was not prevalent in the studies sample of Iranian patients with COVID-19; however, it was associated with a higher odds of extremely severe COVID-19.

Citations

Citations to this article as recorded by

Computational methods for studying relationship between nutritional status and respiratory viral diseases: a systematic review
Zakir Hussain, Malaya Dutta Borah, Rezaul Karim Ahmed
Artificial Intelligence Review.2024;[Epub] CrossRef
A Novel Facet of In-Hospital Food Consumption Associated with Hospital Mortality in Patients with Scheduled Admission—Addition of a Study Protocol to Test the Existence of Effects of COVID-19 in the Same Study in the Post-COVID-19 Period
Hiroyo Miyata, Ayako Tsunou, Yoko Hokotachi, Teruyoshi Amagai
Nutrients.2024; 16(14): 2327. CrossRef
Predictive value of multiple variable models including nutritional risk score (NRS 2002) on mortality and length of stay of patients with covid-19 infections. The INCOVO study
Ghadamieh Fatemeh, Ginette Fotsing, Pedro Marques-Vidal, Peter Kopp, Mohammed Barigou
Clinical Nutrition ESPEN.2023; 55: 357. CrossRef

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